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  5. INTRACOASTAL CARDIOTHORACIC SURGERY, LLC

INTRACOASTAL CARDIOTHORACIC SURGERY, LLC

Company Details

Entity Name: INTRACOASTAL CARDIOTHORACIC SURGERY, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 01 Oct 2003 (21 years ago)
Date of dissolution: 24 Apr 2015 (10 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 24 Apr 2015 (10 years ago)
Document Number: L03000037571
FEI/EIN Number 562475638
Address: 3370 BURNS RD, STE 102, PALM BEACH GARDENS, FL, 33410
Mail Address: 3370 BURNS RD, STE 102, PALM BEACH GARDENS, FL, 33410
ZIP code: 33410
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1710994389 2006-08-03 2020-08-22 3370 BURNS RD, SUITE 102, PALM BEACH GARDENS, FL, 334104327, US 3370 BURNS RD, SUITE 102, PALM BEACH GARDENS, FL, 334104327, US

Contacts
Phone +1 561-694-6911
Fax 5616253239

Authorized person
Name WILLIAM H HEITMAN
Role MANAGING MEMBER
Phone 5616946911

Taxonomy
Taxonomy Code 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 401(K) TRUST 2014 562475638 2015-10-02 INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5616946911
Plan sponsor’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410
INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 401(K) TRUST 2013 562475638 2014-07-07 INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5616946911
Plan sponsor’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410
INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 401(K) TRUST 2012 562475638 2013-08-30 INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5616946911
Plan sponsor’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2013-08-30
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-08-30
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 401(K) TRUST 2011 562475638 2012-10-02 INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5616946911
Plan sponsor’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410

Plan administrator’s name and address
Administrator’s EIN 562475638
Plan administrator’s name INTRACOASTAL CARDIOTHORACIC SURGERY, LLC
Plan administrator’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410
Administrator’s telephone number 5616946911

Signature of
Role Plan administrator
Date 2012-10-02
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-02
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 401(K) TRUST 2010 562475638 2011-09-30 INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5616946911
Plan sponsor’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410

Plan administrator’s name and address
Administrator’s EIN 562475638
Plan administrator’s name INTRACOASTAL CARDIOTHORACIC SURGERY, LLC
Plan administrator’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410
Administrator’s telephone number 5616946911

Signature of
Role Plan administrator
Date 2011-09-30
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-30
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 401(K) TRUST 2009 562475638 2010-12-17 INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5616946911
Plan sponsor’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410

Plan administrator’s name and address
Administrator’s EIN 562475638
Plan administrator’s name INTRACOASTAL CARDIOTHORACIC SURGERY, LLC
Plan administrator’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410
Administrator’s telephone number 5616946911

Signature of
Role Plan administrator
Date 2010-12-17
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-12-17
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 401(K) TRUST 2009 562475638 2010-09-13 INTRACOASTAL CARDIOTHORACIC SURGERY, LLC 0
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5616946911
Plan sponsor’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410

Plan administrator’s name and address
Administrator’s EIN 562475638
Plan administrator’s name INTRACOASTAL CARDIOTHORACIC SURGERY, LLC
Plan administrator’s address 3370 BURNS ROAD SUITE 102, PALM BEACH GARDENS, FL, 33410
Administrator’s telephone number 5616946911

Signature of
Role Plan administrator
Date 2010-09-13
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-13
Name of individual signing WILLIAM HEITMAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HEITMAN WILLIAM M Agent 3370 BURNS RD, PALM BEACH GARDENS, FL, 33410

Manager

Name Role Address
HEITMAN NINA S Manager 3370 BURNS RD, PALM BEACH GARDENS, FL, 33410

Managing Member

Name Role Address
WILLIAM H HEITMAN MD PA Managing Member 3370 BURNS ROAD #102, PALM BEACH GARDENS, FL, 33410

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2015-04-24 No data No data
LC AMENDMENT 2013-02-07 No data No data
CHANGE OF PRINCIPAL ADDRESS 2009-04-22 3370 BURNS RD, STE 102, PALM BEACH GARDENS, FL 33410 No data
CHANGE OF MAILING ADDRESS 2009-04-22 3370 BURNS RD, STE 102, PALM BEACH GARDENS, FL 33410 No data
REGISTERED AGENT ADDRESS CHANGED 2009-04-22 3370 BURNS RD, STE 102, PALM BEACH GARDENS, FL 33410 No data
REGISTERED AGENT NAME CHANGED 2006-04-17 HEITMAN, WILLIAM MD No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2015-04-24
ANNUAL REPORT 2014-04-21
LC Amendment 2013-02-07
ANNUAL REPORT 2013-02-04
ANNUAL REPORT 2012-04-24
ANNUAL REPORT 2011-04-01
ANNUAL REPORT 2010-02-24
ANNUAL REPORT 2009-04-22
ANNUAL REPORT 2008-04-15
ANNUAL REPORT 2007-02-26

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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